Sunday, August 23, 2009

My First Patient

“Doctor, I can’t breathe!”

I stared at our patient: his heaving chest, cerulean eyes, and his pink plastic hair locks. I could hear his eyelids open and close with a loud “click!” His face permanently assumed an expression of astonishment. His soft plastic skin felt disturbingly real. I grabbed his arm and felt his throbbing racing pulse. I looked over to the monitor where I could read his heart rate, blood pressure, oxygen saturation, and body temperature. I leaned closer and stared at his face intensely, as if this was going to rescue him from peril. The room was electric!

“Is it okay if I put an oxygen mask over your face?” my teammate asked gingerly.

“I guess so…”

I was, of course, in a simulation lab. Our patient was a mannequin – a young male with a perfect athletic body, currently posing as a seventeen year-old female with an asthma attack. While simulators like this one can be found in many medical schools around the country, Harvard integrates simulator training into their curriculum starting as early as first year. It was my first ever interaction with a patient.

It was an amazing and novel experience for me. I really liked working with my teammates. We scrambled together to come up with possible solutions for our patient. We asked questions about our patient’s history, their medications, their allergies and whatever else we could think to ask but in no particular order. For instance, we completely forgot to ask their name! Being in a simulated Harvard Emergency room, we could request to perform any test and administer any medication.

“My chest really hurts! It’s hard to breathe!”

“Give us an albuterol inhaler, please!” we asked.

My teammate sprayed two clicks of albuterol into our patient’s wide-open mouth. We looked over at the vital signs on the screen, waiting for a change. And there it was: oxygen saturation went up, signifying to us that our actions helped the patient. We smiled at each other, but our mannequin still complained.

“My chest really hurts!”

My happy feeling was gone. “What’s wrong with her heart rate? Why is it so high?” I wondered. I was really hoping for her to be happy and relieved. We ordered a chest X-ray. It came up on a huge flat screen, looking very pretty in high-res. I was staring at it, hoping to see the solution to this poor young woman’s problem. “Why does her chest hurt? What can I do for her?” I felt so bad. It felt so amazingly real! My heart was racing.

We found nothing obvious on the X-ray, but the consensus was reached that this woman was having an asthma attack. What to do now? We brainstormed a list of medications, but none of us was certain enough of how they were supposed to be administered.

“Let’s call her primary care physician” somebody suggested.

“Yes, let’s do that.”

“What’s their name?” We all looked at each other, puzzled by this basic piece of information.

It was our good fortune that we were able to obtain the name from our patient. We got her primary care physician on the phone and asked about her asthma history. We were told that she keeps it in check pretty well with steroids.

“Ah, steroids! Yes, let’s give her some steroids!”

The steroids brought our patient the desired relief. We successfully admitted her into the hospital and the case was over. Our instructor came out from behind the curtain, smiling. She was incredibly supportive, and discussed the case with us in great detail. She reviewed our performance and made suggestions how we could improve. We were supposed to notice that our patient’s chest was overinflated on the X-ray, but none of us noticed that. The white specs in the center of the film that I thought could have been some foreign body or dust were in fact normal blood vessels and airways. Her heart rate was elevated due to albuterol which we administered early on. It all finally made sense!

I was mentally drained, but thought the whole experience was incredible. My meager performance gave me a boost of enthusiasm, actually. I wanted to go to the library immediately to learn about asthma and the treatments for it. Next time I will know what to do!

On my way home I was reflecting on the events of the day. Absentmindedly I looked around the train car. It was crowded with people returning from work; wary faces, reading newspapers, listening to iPods, swaying to the rhythm of the train. “What if all of them suddenly had an asthma attack,” I suddenly thought with penetrating terror. I turned my head and saw a pregnant woman standing by the door. “What if she had an asthma attack? What on Earth would I do if that happened?”

But the sim lab did not give me lasting nightmares. Rather I had a new awareness that emergencies do happen and that I need to learn to be ready for them. It motivated me.

6 comments:

  1. Very interesting. Perhaps increased heart rate may result from the epinephrine effect of the Albuteral inhaler??? Why so we have increased rate of asthma in US?? Did you know asthma attackes can be precipitated from cockroaches in one's environment?? On the train caar, without a pulse oximeter, you could evaluate one's level of distress by use of the peak flow spirometer! Patient should know personal best and the peak flow can show if the patient is in a safe (yellow or green zone) or red zone.

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  2. It was an amazing experience! I am so grateful to have sim lab as a resource!

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  3. Keep your posts coming! We'll be following you through this incredible journey! Thanks for sharing so much with "us" out here

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  4. This comment has been removed by a blog administrator.

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  5. Very nice blog and very informative post. Thanks for sharing with us. Keep posting like this.
    X-Ray Simulator Training
    Thanks.

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  6. Hi I'm an mbbs graduate from India n I love your blog! How come there aren't any posts after 2011 ? Do write up...cheers

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